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Cardiac reoperations in octogenarians: analysis of outcomes
1Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Insights
Cardiac reoperations in octogenarians show acceptable long-term survival and improved quality of life, despite increased risks. Earlier intervention may further enhance outcomes for this elderly population undergoing complex heart surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Increasing number of elderly individuals, particularly octogenarians, require complex cardiac interventions.
- Data on outcomes, quality of life, and long-term results of reoperative open-heart surgery in octogenarians are limited.
Purpose of the Study:
- To evaluate the outcomes, quality of life, and long-term results of reoperative cardiac procedures in octogenarians.
- To compare outcomes between different types of reoperative procedures in this age group.
Main Methods:
- Retrospective study of 113 consecutive octogenarians (mean age 83 years) undergoing reoperative cardiac procedures over 13 years.
- Procedures included coronary artery bypass grafting (CABG), valvular procedures, and combined CABG and valve interventions.
- Analysis of 30-day mortality, actuarial survival rates, functional status (New York Heart Association class), and patient-reported quality of life.
Main Results:
- 30-day mortality rates were 8% (CABG), 9% (valve), and 17% (combined).
- 1- and 5-year survival rates ranged from 53-85% and 58-63% respectively, varying by procedure type.
- Significant proportions reported improved quality of life (80-91%) and functional status (38-61% NYHA class I/II) post-surgery.
Conclusions:
- Cardiac reoperations are feasible in octogenarians, offering acceptable long-term survival and improved quality of life.
- The combined CABG and valve group faced higher risks.
- Earlier referral and surgical intervention may optimize outcomes and healthcare resource utilization in this high-risk demographic.
Background:
With the rapid growth of the elderly segment of the population, more octogenarians are referred for complex cardiac interventions, including reoperations. Data regarding the outcomes, quality of life, and long-term results after reoperative open-heart surgical procedures in octogenarians are scarce.
Methods:
We retrospectively studied 113 consecutive octogenarians (mean age, 83+/-2.6 years) who underwent reoperative cardiac procedures within a 13-year period. Coronary artery bypass grafting (CABG) was performed in 49 patients (CABG group), valvular procedures (aortic, mitral, or tricuspid valve, alone or in combination) in 35 (valve group), and combined CABG and valve intervention in 29 (combined CABG and valve group).
Results:
The 30-day mortality rate was 8% (4 of 49) for the CABG group, 9% (3 of 35) for the valve group, and 17% (5 of 29) for the combined CABG and valve group. One- and 5-year actuarial survival rates were, respectively, 85%+/-5% and 58%+/-10% for the CABG group, 78%+/-7% and 53%+/-12% for the valve group, and 69%+/-9% and 63%+/-10% for the combined CABG and valve group. Sixty-one percent of patients in the CABG group, 40% in the valve group, and 38% in the combined CABG and valve group were in New York Heart Association class I or II postoperatively at a mean follow-up time of 2.1+/-2.4 years. Similarly, 91%, 85%, and 80%, respectively, thought that they had an improved quality of life and were satisfied with their functional status.
Conclusions:
Cardiac reoperations can be performed successfully in most octogenarians, although with an increased risk, particularly in the combined CABG and valve group. Long-term survival is acceptable with improved quality of life and functional status. However, it is possible that these results could be improved in this high-risk group of patients with earlier referral and surgical intervention, for the effective use of health care resources.